The 4th-year milestone

The 4th-year milestone is like a magnetic compass, giving us a sense of North whenever our perception is in limbo, blurred by waves of madness voraciously thirsty for the inner fears buried deep within our minds. Once you get over the hurdles of the first three years in your medical training, chances are you will graduate as a doctor. The odds are in your favour since you have made it to the other half of the story.

Welcome to paradise. Shorter school days, workload reduction, and schedule flexibility all contribute to the oasis you have been dreaming of becoming a reality.

The block system is a game-changer. You are no longer tackling 2-3 major subjects – and a bunch of minor subjects – throughout the school year intending to pass a final exam in June. Instead, you will be rotating in the different hospital departments. Most courses have a week’s duration. A few last a fortnight. The exams are written at the end of each course, usually on a Friday, with a few exceptions.

Since every seminar group (16-20 people) has a different schedule, not all your peers will be studying the same topic in a given week. Classes start anywhere from 7:30-9:30 AM with a theoretical seminar, followed by a small break and a practical class where each clinical group (composed of 4 students) follows a different doctor in the clinic. Between 12:00-14:00, you will be calling it a day.

Without further due, let’s start our 4th-year dissection. Subjects to be taken seriously are anaesthesiology, cardiology, dermatology and neurology. In my opinion, the rest requires minimal effort to complete. Furthermore, you will complete the following courses – anaesthesiology, clinical pharmacology, neurology, nuclear medicine, patient safety, and surgery – by writing a final exam at the same time as all your 4th-year peers.

Anaesthesiology – 3 ECTS (2 weeks)

If anything, these two weeks made me realise that I will not pursue this field of medicine. I find that many look up to anesthesiologists for their deep understanding of physiology and pharmacology. While I do consider their role pivotal in a variety of situations, I have failed to foresee how much of their skill is procedural, dictated by guidelines and improved by technology. Honestly, I am all for technology that extinguishes human error. Perhaps, I have been rather naive by making assumptions concerning anaesthesiology that do not correspond to the reality of it in everyday practice. The dealbreakers for me are the long working hours, dealing with critically ill patients in the Intensive Care Unit (ICU), and playing a limited role in the operating room. A couple of the theoretical seminars were interesting but the thrill of anaesthesiology usually kicks in during the practical classes. Probably the best day of my journey as a medical student happened while taking this course. My clinical group was lucky enough to witness 3 different surgeries in one morning. The last surgery was performed by a well-known ophthalmologist on a patient with PEX syndrome. An intraocular lens implant was needed to save the patient’s sight and it was the most impressive procedure I have ever seen. The surgeon explained in great detail what was going on in every step of the way as he looked into the patient’s eye through a microscope. I was astonished during the operation and the weeks to follow. That day was unforgettable. All students must write the final exam in June after every seminar group has completed the rotation. Due to the COVID-19 lockdown, most of us had an online exam. 45 MCQ and 60 minutes.

Neurology – 3 ECTS (2 weeks)

You will have the opportunity to experience the practical aspects of neurology working with adults and children. Moreover, you will become good at performing a neurologic physical examination. Having a good grasp of neuroanatomy is a plus to do well. However, the focus this year is purely clinical. Therefore, you will be reading a lot more about neurologic genetic diseases, strokes, epilepsy, migraines, dementia, etc. At the end of the course, you should have a better idea of how to tie symptoms together, which lab tests to order based on differential diagnosis, and how to rank the different treatment options (if any available). At the end of the second week, you will have to examine a random patient and write a report. Moreover, there will be an oral exam. Every clinical group gets a different examiner. The final exam is written at the end of the first semester – usually late January – by all students simultaneously. 80 MCQ and 5 open questions. A total of 90 minutes. 60% in both parts are needed to pass the written test. You better study because the exam is rather challenging. Scores from the oral exam, patient report and written test will be added together and determine your final grade. The good news for those of you who are not neurology enthusiasts, including myself, is that this is the end of the road for us. No more neurology until graduation. If you are a neuro nerd please do not despair for you will be given the chance to take neurology as an elective course in 6th-year.

Surgery – 3 ECTS (2 weeks) + Cardiac surgery – 2 ECTS (1 week) + Vascular surgery – 2 ECTS (1 week) + Neurosurgery – 1 ECTS (1 week)

Surgery is one of those subjects that you either love or disregard. I had already gotten a little taste of it in my 3rd-year so there was not much of a surprise this time around. It is the perfect field for those of you who love working with your hands and seeing immediate results. You will probably thrive in the operating room (OR) if you have a knack for procedures, enjoy teamwork, and accept that you will be entering a world where hierarchy is well established. Needless is to say that during these rotations you dive deep into the most common surgical procedures performed in a variety of clinical pictures. Neurosurgery was not nearly as cool as I expected. There are many situations where there is nothing we can do for the patients. Sadly. Most of the operations are done when the superficial layers of the brain and/or spinal cord are involved. Tumours that affect deep structures are inoperable more often than not. The neurosurgery exam is done at the end of your rotation and it consists of 10 questions. In other words, each seminar group has a different test. Surgery’s written exam is at the end of the year, in June. 30 MCQ and 30 minutes – online exam due to COVID-19.

Nuclear medicine – 1 ECTS (2 days)

The good news regarding this course is that your group representative can negotiate with the department and shorten its duration. My group had it over 2 days, giving us the luxury of extra free time during that week. The test is written somewhen in the second semester.

Clinical Pharmacology I – 1 ECTS

There will be a 2 hours long seminar once a week for 4 weeks. Unfortunately, attendance is mandatory. Here, you go over the high-yield pharmacological agents once again, focusing a great deal on the adverse reactions and drug-drug interactions. The test will be written at the end of the first semester. 40 MCQ and 50 minutes.

Patient Safety – 1 ECTS

Lectures are mandatory and presence will be checked. The content to be learned is a no brainer.

Rehabilitation – 2 ECTS (1 week)

The theoretical part of the course is rather boring. As for the practical classes, I liked the wide range of options available to the patients and learned something new every day of that week. The test consists of 20 MCQ.

Radiology 1 – 2 ECTS (1 week)

Another course that you either love or hate. Nobody seems to stand in neutral territory in regards to radiology. Every day of the week, your clinical group will be focusing on a different imaging technique – X-ray, CT scan, USG and MRI. On Friday, there will be a longer seminar and an anatomy pint test at the end. No practical classes that day. 

Gynaecology and Obstetrics – 2 ECTS (1 week)

The first three days of the week will be spent in the classroom going through all the theory. The practical aspect of gynaecology involves a combination of outpatient clinic and surgery. An option to consider for those who crave variety in their profession. I wish I could erase from my memory some of the things I saw during the practical classes. In summary, it was painful to watch the curettages. The test consists of 20 MCQ and you are given a total of 20-25 minutes.

Internal Medicine (Cardiology) – 2 ECTS (1 week)

Cardiology is one of the toughest subjects. You will dive deeper into the world of ECG’s, meaning that by the end of the cardio week you will be pretty good at analysing them. Be on time because some teachers are obsessed with punctuality. Nevertheless, be mentally prepared to wait a long time before the early seminars start. Ironically, other teachers within the same department do not understand the concept of time. The final exam happens on a Monday – so you have 48 hours as a bonus to prepare – and consists of 10 MCQ and the analysis of 2 ECG’s. 60% in both parts must be achieved to pass. In case you fail it, the resit happens at the end of the semester. If you fail it the second time around, you will have an oral exam at the end of the year.

Internal Medicine (Nephrology) – 2 ECTS (2 weeks)

One of the best courses in terms of organisation. The first seminars are used to recap the renal anatomy, physiology and pathology. Most of the teachers are highly competent and communicate well with students. The practical classes are interesting. You will learn a great deal about dialyses and renal transplantation. The test contains 20 MCQ and you are given more than enough time to complete it.

2019-2020 academic year was marked by a global pandemic (COVID-19) which forced the fast-paced world we live in into a halt. Regular classes were cancelled in the middle of March 2020 and online learning took over thereafter. Unfortunately, due to the lockdown students were not allowed in the clinic for the rest of the academic year. We are currently making up for the time lost by taking as many practical classes as possible before 5th year officially starts. The following courses were conducted during the peak of the pandemic in Europe. 

Ophthalmology – 3 ECTS (2 weeks)

I love everything about the eye so I was hungry for this one. Interesting anatomy, countless pathologies and sophisticated, complex machines are used in the treatment approach. A medical field that seems to offer a good lifestyle, a wide range of possibilities for further specialisation, and in which you can impact someone else’s life tremendously. A lot of material is covered during these two weeks. There is an exam at the beginning of the course in which you are tested on the anatomy of the eye. At the end of the second week, the written test consists of 20 MCQ. Besides, there is an oral exam.

Dermatology – 4 ECTS (2 weeks)

I love the fact that this department posted all the reading materials online and gave us the freedom and flexibility to study at our own pace. Lovely. I finished the practical classes today and I must say that dermatology is totally out of my league. Skin pathology is fascinating. Particularly, skin malignancies. However, I am afraid that I will get quickly bored working as a dermatologist. Looking at different rash patterns and describing skin lesions can only be that much fun in the long run. There is a written and oral examination at the end of the course. The written exam consists of 20 MCQ questions and my oral exam is yet to be scheduled.

Internal Medicine (Hypertension and Diabetology) – 2 ECTS (1 week)

Can I summarise this course in one single word? Definitely yes! Guidelines. Trust me. It’s all about the guidelines. Hypertension classification? Which drug is the most appropriate for a specific population group? Check the guidelines. The answer will not change regardless of the question you dare asking.

Psychiatry II – 3 ECTS (1 week)

Same old, same old. Whether you like it or not just go with the flow. Psychiatry is so broad that makes it difficult to completely fail at establishing a differential diagnosis.

Paediatrics – 4 ECTS (2 weeks)

Honestly, this one has never been a favourite of mine. How easy would it all be if one only had to apply his/her internal medicine knowledge to smaller bodies? Children and teenagers are experts at changing the rules of the game. And just like that, you must rewire your brain, relearn everything you have been taught thus far. As for the practical classes, my group will have them somewhen in October. 

Neonatology – 2 ECTS (1 week)

Neonatology left a positive mark on my path. Neonates are the cutest little ‘things’ you will encounter at the hospital. Theoretically, not my cup of tea.

Gastroenterology – 2 ECTS (1 week)

If GI pathology is up your alley you will enjoy this course. Cancer is a big part of it. I saw a couple of colonoscopies during the exercises. Similarly to gynaecology, I wish I could get rid of the flashbacks my brain keeps on playing whenever triggered by external impulses. Maybe the real question I should ask myself is whether I have a problem with uncomfortable, invasive procedures or with the anogenital region.

What books should you consider obtaining? The First Aid USMLE Step 1 book is on the top of my list recommendations. It is a great way to wrap up all the theoretical knowledge required to better understand what you will see in the hospital. Trust me when I say that using this book as a complement to the reading materials provided by the school will only benefit you. Students tend to use The Only EKG Book You’ll Ever Need when preparing for the cardiology exam. I gave it a try but did not enjoy the reading. Instead, I strongly recommend The ECG Made Easy. Concise, easily understandable and therefore fun to read. ECG by example is also a must since during your exam you will have to analyse 2 random ECG’s taken from this book. The book contains 100 ECG’s with explanations. Good enough to worth the buy. The Oxford Handbook of Clinical Medicine is another good purchase. It is a pocket-sized book and it has everything you need to know to do well in the clinic.


In one word, 4th-year is freedom. It is the perfect year to prepare for the USMLE exam if you are keen on working in the United States of America, get involved in research, optimise your work-life balance, find a new hobby, travel, explore Gdansk, expand your network in Poland, etc.

Classes start in two days – Monday, the 5th of October – and the excitement is finally hitting me. For now, all lectures/seminars are going to be online. Practical classes will be squeezed into 1-2 days every week to minimise the risk of COVID outbreaks. 

Good luck everyone! 


The calm before the storm

Back into the maze

Final lap I

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